Fussy eaters: When should I worry?

It’s a common question from parents of small children, as most kids go through a phase of rejecting certain foods. Here, experts tell when to seek help and what you can do.

The eating patterns we develop in childhood can have a strong influence on what we choose to eat as adults. So if your child refuses to eat fruit and vegetables, it’s quite natural to fear that he or she will grow into an unhealthy adult who lives on pizza, pasta and bread.

Most kids have an issue or two with specific foods at some stage. So if you’re faced with a child who’s resistant to eating greens or any other essential foods, the first thing to do is recognise that some degree of food fussiness is normal. But if you’re trapped in a vicious cycle of mealtime cajoling that escalates into anger, tears and tantrums, you’ll be happy to hear that there are strategies available to help shift these stubborn patterns.

The good news? Not all fussy eaters become fussy adults. Many youngsters merely go through a phase and grow out of it.

Fussy, but normal

As you may have noticed, most pre-schoolers show some dislike to certain foods, particularly fruits and vegetables.

Fussy eating habits can occur at any stage up until 6 years of age, often starting from around the time toddlers begin to walk. In one sense, these habits reflect that the child is stepping into the world and exerting a new-found autonomy in one of the few ways he or she can. Unwelcome as it may be, this finicky behaviour can even protect children from eating harmful foods.

Thankfully, most kids outgrow their aversion to bitter flavours, and you can play a key role in encouraging this development. A clever and consistent parental influence and good behavioural management can help kids move beyond fussy eating and go on to enjoy food in an adventurous and healthy way. (For solutions to the most common fussy-eating problems, see ‘Four fixes for fussy eaters’ below.)

Just a picky eater

Some children maintain strong food likes and dislikes beyond the ages we normally associate with fussy eating. These kids are also called ‘selective eaters’.

Food presents children with a variety of sensations, including taste, texture, odour and colour, all of which have a huge impact on their preferences. Other major influences are the eating habits of peers and family members, as these can easily sway a child’s decisions about food.

Picky eaters have strong food preferences and aversions, and they may even require special preparation of their foods.

When picky eating becomes a problem

Children who are seen as picky eaters may still be consuming sufficient amounts of energy and key nutrients, even if they’re choosing to eat only 10 foods or fewer. Such children consistently display normal growth and development, and their diets have no impact on their bone density. Sometimes, recognising that a finicky child is still a healthy child is enough to relieve parents’ anxiety, which gives them the confidence to persevere with strategies to gently expand their child’s food options.

Kids who are past the preschool years, yet still resistant to foods, can reach a turning point when their picky eating starts to affect their social relationships. Realising they’ll feel awkward or be unable to attend school camps or friends’ sleepovers can suddenly create a willingness in them to change.

In rare situations, picky eating can indicate an underlying problem. Food allergies usually manifest in young children in fairly obvious ways; however, food intolerances can be more subtle, presenting as minor gastrointestinal disturbances, or as other symptoms that parents may initially fail to notice. Children who have food sensitivities can develop a natural aversion to some foods, such as broccoli, tomato or mushrooms, for example, as these foods are very high in salicylates and glutamates. If you suspect that your child has a food intolerance, the only recognised way to pinpoint the problem foods is to implement an elimination diet. You’ll need to do this with the help of an accredited practising dietitian (APD), who can supervise the process.

Beating picky eating

Creating healthy-eating habits in childhood demands patience and commitment. Picky eaters may need more individual exposures to a new food or drink than other children do, for starters.

Creating a positive environment at the table is also crucial to successful change. If mealtimes have become stuck in a pattern of wilful resistance and escalating tension, it’s time to adjust your approach. Pressure to eat or arguing about food can worsen picky eating. At meals, decide on the foods you want your fussy child to eat, then try some of the strategies in the ‘Action plan for anxious parents’ below. At other times, show your child that being around food is an enjoyable experience: Involve a picky eater in cooking, food shopping and vegie gardening to increase his or her exposure to food in a positive way.

Record eating patterns

Sometimes, kids eat a lot more than we think they do, especially picky eaters. To get an accurate picture of what’s really going on, keep a food diary for three to five days. If you identify exactly when and where your child is eating throughout the day, you’ll work out why he or she refuses to eat at certain meals. If various people supervise your child during the day, you may find that he or she is snacking on preferred foods too often, and is therefore simply not hungry at other times.

A record of your child’s eating habits is also helpful if you plan on seeing a dietitian.
It can be reassuring to realise that the bland, nutrient-poor diet you see your child consuming looks quite different to a nutrition expert, who is better equipped to identify the less obvious sources of nutrients in his or her diet.

Talk at the table

If you’re satisfied that lack of hunger isn’t the issue, the next step is to modify the foods you’re serving. There’s no reason to cause unnecessary angst by removing all your child’s favoured foods, but if these foods are nutrient poor, now is the time to reduce both their amount and your child’s access to them.

You can also choose to stagger serving individual foods at mealtimes. If you take this approach, talk to your child about hunger levels and the need to stop eating when the tummy feels full. You could say, “If you’re not hungry enough to eat these green beans, your tummy must be full, and if your tummy is full, you’re not hungry enough to eat these potatoes.”

You’ll need to be patient and persistent, as fussy eaters need more exposure to a food to accept it than normal eaters do. Always make sure there’s something on the plate that your child can and will eat, and slowly introduce new foods. This may mean having a spoonful of a new food in a separate bowl on the table. Some children may not even touch it that first time, but the next night, you could put it on the child’s plate. After that, you could ask him or her to smell or lick the new food, and then to take a small bite.

Be patient

Go slow, but stay firm about having your child move beyond his or her level of comfort. It’s also important to avoid using food to reward improvements in eating or any other behaviours. Remember: You’re not going to solve a fussy eater’s issues in a single sitting. When you’re addressing what may be years of learned behaviour, you have to acknowledge that change takes time. Be prepared to start slowly, be consistent and involve the whole family.

It’s never too late to address picky eating, but the older your child is, the more committed he or she needs to be. To establish good eating habits for the long term, a child must be an active participant in the process, and a parent must be prepared to seek professional help.

Where to get help

If you’re at all concerned about a picky eater, the best strategy is to see an appropriate health professional. Simply talking to a dietitian or nutritionist can be enough to allay your fears.

For any health issues that concern a child, your first step should be to see your family GP. A doctor can identify whether any developmental issues are affecting your child’s diet and, if necessary, can refer you to an accredited practising dietitian (APD) or clinical psychologist. You can also search for a local APD at Dietitians Association of Australia, refine your search to find a dietitian who specialises in paediatric nutrition.

Nutrition Australia offers many helpful resources and fact sheets, including tips for dealing with fussy eaters and training toddlers’ taste buds, as well as great school-lunch-box ideas.

Four fixes for fussy eaters

1. “She rejects all new foods”

Encourage your daughter to taste one new food at a time. At first, just ask her to sniff or lick it. Next time, urge her to take a small bite. Remember that she’ll still need multiple exposures to the same food. Reward her efforts with non-food treats, such as toys or stickers. This way, you’ll slowly build up her list of acceptable foods.

2. “He won’t eat mixtures of food”

Start by placing separate foods on the plate, then gradually move the foods closer together over the following days (or weeks). One by one, offer your son mixtures of two foods, then three and so on. Suggest that he could combine the foods himself.

3. “She refuses to eat green vegetables”

Fruits and vegetables have similar nutrients, so if your daughter won’t eat vegies, increase her fruit intake. You’ll often find there’ll be at least one vegetable that she will eat, so serve her a larger helping of it, and don’t worry about her eating too much of it. Meanwhile, continue to expand her diet with the simple three-step taste strategy described above.

4. “He eats only one kind of yoghurt”

If your son tolerates only one flavour or one brand in a food category, talk to him about why he likes that particular brand and why he dislikes others. Take him to the supermarket and ask him to find a similar product that he’s open to trying—and start there.

An action plan for anxious parents

These simple strategies can help children overcome fussy eating and encourage them to eat a wider range of healthy foods.

Be a good role model. Eat plenty of fruits and vegetables, drink water and milk, and try new foods. A parent’s acceptance of new foods has a strong influence on a child’s food preferences.

Focus on cultivating a positive attitude to food. Create a relaxed, comfortable environment at mealtimes. Stress only discourages kids from trying new foods.

Keep a variety of healthy foods on hand. Ensure there’s an accessible supply of healthy meal options and nutritious snacks, and limit the availability of unhealthy processed foods.

Empower kids. Remember: Parents choose which foods to serve; children decide how much to eat. Provide age-appropriate portions and respect your child’s appetite. If the only choices are nutritious, a hungry child will eat them, but giving children access to junk food makes it harder to control their choices.

Prepare the same meals for the whole family. When pre-schoolers eat the same food as their parents do at the same time, they eat more fruits and vegies. Eating together not only allows them to absorb your healthy-eating habits, but also encourages social interaction. Preparing separate meals may promote picky eating.

Create enjoyable food experiences. Take children to the supermarket and ask them to select fresh fruit and vegies, among other foods. Plant a vegetable garden together, let them rinse vegies for dinner or ask them to set the table.

Mix it up. Add chopped or pureed vegies to soups, sauces and casseroles. Bear in mind that this may be easier with mildly fussy eaters. Very picky children may taste the hidden vegies, refuse the dish and become even more nervous about mixed dishes.

Be persistent. To happily eat an unfamiliar food, most children need to confront it 10 to 15 times, or to taste it every day for a fortnight, yet many parents mistakenly give up long before then. And highly fussy children may need even more than 15 exposures.

Limit juice and sweetened drinks. Avoid diluting kids’ appetites: Offer water between meals and snacks, and only juice or milk with meals or just after.

Stick to a routine. Serve meals and snacks around the same time every day, leaving at least 1.5 to 2 hours between snacks and main meals so children have a good appetite at mealtimes.

Minimise distractions. Switch off the TV, computer and ‘i’ devices to help kids focus on the food.